This study further contributes to the understanding of the impact of death and dying on professionals who care for dying patients and their families. Despite the stressors and the potential for burnout and compassion fatigue, these participants employed strategies that enhanced meaning-making and emphasized the rewards of their work. However, the consequences of work stressors cannot be underestimated in the practice of palliative care.

Background Chronic obstructive pulmonary disease (COPD) is an increasing cause of mortality. However, people with COPD are unlikely to receive care that meets the needs of themselves or their carers at the end of life. Aims To explore the needs of people with end‐stage COPD in South Australia and develop recommendations for a model of care. Methods Three related studies were undertaken: in Study 1, 15 people with advanced COPD and their carers were interviewed twice, 6 months apart; Study 2 investigated views of an Expert Panel and Study 3 conducted focus groups and interviews with service providers and community groups to examine service availability and accessibility. Results This project demonstrated that the needs of people with COPD are not being met. There was an absence of a coordinated pathway for support. Care was fragmented, episodic and reactive. The role of carers was poorly recognised. Health professionals identified the lack of a clear transition to an end‐stage and significant barriers to obtaining support for activities of daily living. Communication issues were identified in all studies, including the absence of advance care planning conversations. Conclusions A flexible model of care is needed that assists people with COPD to navigate the health system. This should be patient centred and coordinated across primary, acute and community sectors. Neither respiratory nor palliative care services alone can adequately support people with COPD. The integration of a multidisciplinary palliative approach within a chronic disease management strategy will be central for the best care for people living with advanced COPD.

Teamwork is an integral part of the philosophy of palliative care. Cross‐functional, interdisciplinary teams offer benefits to patients, practitioners and specialist areas of care. Leadership of teams can be difficult. With shared responsibilities, more than the sum of the competencies of team members can be offered. In palliative care the final decision‐maker is the patient.

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ObjectivesThe aims of this survey of healthcare interpreters were to assess the impacts of difficult conversations such as discussions involving explanation of a serious diagnosis, goals-of-care or death or dying and to discover interpreters’ opinions on ways to improve these conversations.MethodsA purpose derived survey incorporating the Professional Quality of Life measure 5 was distributed to all healthcare interpreters in an Australian state. Outcome measures were to quantify levels of compassion satisfaction (CS), burn-out and secondary traumatic stress (STS), as well as to determine how well interpreters believed difficult conversations were being conducted and suggestions for improvement.ResultsThere were 94 respondents all scoring moderate (34.1%) or high (65.9%) on the CS score. No respondents scored high on burn-out or STS scales. Significant subgroup analysis was those aged 18–30 with higher burn-out scores. The two most common concerns raised were (1) not knowing the content prior to a discussion and (2) feeling guilty about delivering bad news. The two most frequent suggestions for improvement were (1) prebriefing with medical teams prior and (2) allowing opportunity to explain cultural concerns.ConclusionsInterpreters surveyed were not experiencing burn-out or STS and had moderate or high CS scores. Recommendations are: further training and evidence-based guidelines for medical staff and healthcare interpreters in the facilitation of difficult conversations; prebriefing and debriefing for interpreters; further research to delineate the characteristics that predispose to compassion fatigue.